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The Health Project: An Introduction to The C. Everett Koop Awards – How Have Employers Demonstrated Success in Health Promotion and Disease Prevention?

Ron Z. Goetzel, Ph.D., Emory University and Thomson Reuters Healthcare

HPCareer.net -- Health Promotion Live - January 12, 2011

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AGENDA

• An Introduction to The Health Project and Dr. C. Everett Koop Award

• How to Apply for the Award

• Frequently Asked Questions

• Past Winners – Documenting Health Improvement and Cost Savings

– Pepsi Bottling Group

– Citibank

– Johnson & Johnson

– Procter & Gamble

– King County

• Summary and Future Webinars

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The Health Project C. Everett Koop National Health Award

• Non-profit , public-private partnership

that recognizes organizations that have

demonstrated health improvements and

cost savings from health promotion and

disease prevention programs.

• At its launch in 1994, The Health Project

recognized the following organizations:

Johnson & Johnson, Aetna, Dow

Chemical Company, L.L. Bean, Inc.,

Quaker Oats Company, Steelcase, Inc.,

and Union Pacific Railroad.

• The Health Project is dedicated to

improving American’s health and

reducing the need and demand for

medical services through good health

practices.

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The Health Project Board of Directors

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• Honorary Chairman C. Everett Koop, MD, ScD

– The C. Everett Koop Institute at Dartmouth

• Chairman and Co-Founder Carson E. Beadle

• President and CEO Ron Z. Goetzel, PhD

– Emory University, Institute for Health and Productivity Studies

and Thomson Reuters

• Chief Science Officer James F. Fries, MD

– Stanford University School of Medicine

• Secretary/Treasurer James Wiehl, JD

– Fulbright & Jaworski

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The Health Project Board Members

• Steve Aldana, PhD WellSteps

• David R. Anderson, PhD StayWell Health Management

• David Ballard, PsyD, MBA American Psychological Association

• Karen Glanz, PhD, MPH University of Pennsylvania

• Willis B. Goldbeck Institute for Alternative Futures

• Joseph A. Leutzinger, PhD Health Improvement Solutions, Inc.

• Molly McCauley, RN, MPH Hoffmann-LaRoche, Inc.

• Michael O’Donnell, PhD American Journal of Health Promotion

• Ken Pelletier, PhD, MD (hc) University of Arizona School of Medicine

• Bruce Pyenson, FSA, MAAA Milliman

• Seth Serxner, PhD, MPH Mercer Human Resource Consulting

• Stewart Sill, MS IBM Integrated Health Services

• Jacque J. Sokolov, MD SSB Solutions

• John F. Troy, JD Public Policy Consulting

• George Wagoner, FA, MAAA William M. Mercer, Inc.

• Ex Officio:

• Catherine Gordon, RN, MBA Centers for Disease Control and Prevention (CDC)

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Supporters and Sponsors of The Health Project

– James F. and Sarah T. Fries Foundation

– Health Fitness Corporation

– Health Enhancement Research Organization (HERO)

– William M. Mercer

– Pepsi Bottling Group, Inc.

– StayWell Health Management

– Thomson Reuters

– USAA

– National Institute for Health Care Management

– Lincoln Industries

– Johnson & Johnson

– Prudential

– United Healthcare Services

– Highmark

– Value Options

– Eastman Chemical

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Our Website -- http://www.thehealthproject.com

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2010 Winners and Honorable Mentions

2010 Winners

• Medical Mutual of Ohio - Wellness for Life

• Pfizer - Healthy Pfizer

• The Volvo Group - Health for Life

2010 Honorable Mentions

• American Federation of State, County, and Municipal

Employees Council 31 - HIP - Benefit Plan for Better

Health, Health Care & Well-Being

• Berkshire Health Systems - Wellness at Work

• Lowe’s Companies, Inc. - Life Track

• Trek Bicycle Corporation - Trek Wellness

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Recent Winners

2009 Winners

• Alliance Data, healthyAlliance

• L.L.Bean, Inc., Healthy Bean

• Nationwide Mutual Insurance Company, My life. My choice. My

health

2008 Winners

• The Dow Chemical Company, LightenUp Program

• Energy Corporation of America (“ECA”), ECA Platinum

Wellness Program International Business Machines (IBM),

Wellness for Life

• Lincoln Industries, Wellness – go! Platinum

• Vanderbilt University, Go for the Gold Wellness Program

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Dr. Koop with Winner -- IBM

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Dr. Koop with Winner – Vanderbilt University

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Dr. Koop with Winner – Dow Chemical

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Koop Award Application – Available at: www.thehealthproject.com

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Submission Deadline

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The Health Project –C. Everett Koop National Health Award

• To receive the Koop Award, there are three considerations:

– 1) The program must meet The Health Project’s goal of

reducing the need and demand for medical services,

– 2) Share the objectives of the Healthy People health

promotion targets, and

– 3) Prove net health care and/or productivity cost

reductions while improving population health.

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Frequently Asked Questions (1)

• Are there minimum requirements for application?

– No specific requirements are set regarding participation rates, risk

reduction, and cost outcomes because of unique challenges that may

face any given applicant. However, it would benefit the applicant to

demonstrate high participation in a program, which is comprehensive in

nature (not single focus), net risk reduction, and cost savings that

exceed program expenses. Longer term programs (3+ years) are

generally higher rated than those in their beginning stages.

• What are programs evaluated on?

– Adherence to evidence-based practices, comprehensiveness,

participation rates, health improvement/risk reduction, and net cost

savings.

• Are requirements different for small and large organizations?

– Smaller organizations are not expected to do a sophisticated claims

analysis. If they can document cost stabilization over 3-5 years (without

significant benefit plan design changes or other utilization management

measures), that is often considered sufficient in terms of demonstrating

cost savings. 16

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Frequently Asked Questions (2)

• Does a published article serve as a gold standard?

– Yes, if it informative of evaluation results demonstrating health

improvement and cost savings. But, it is not a requirement.

• Is financial impact required or is change in risk status and utilization

sufficient?

– Health behavior change/risk reduction plus cost savings are required. If

the organization claims a positive return-on-investment (ROI), then both

savings and program costs need to be documented. Reduced utilization

translated into financial impact may be considered as long as this is not

achieved through benefit plan design, rationing, outsourcing, or

utilization review. There needs to be a link to health improvement and

risk reduction.

• Are vendor reports as good as independent third party analyses?

– Independent analyses wield greater influence, but vendor reports are

acceptable if they have well-documented methodology and are credible.

• What supporting materials are required?

– N’s, tables/graphs with clear annotation, statistics.

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Frequently Asked Questions (3)

• How are Winners determined?

– Applications are independently reviewed and scored by Board members.

Reviewing Board Members rate applications on a 100-500 scale, where

a score of 100 represents a superior program. Reviewers score

applications using their best judgment, and specific criteria, with greater

emphasis placed on program evaluation and results. Scores of 300 or

above indicate that the reviewer considers the application to be non-

competitive for a Koop Award.

– Scores from all reviewers are averaged with and without outliers (i.e.,

before and after dropping the lowest and highest values). Applicants with

average scores below 300 are considered for the Koop Award.

Applications with scores greater than 300 remain eligible for an

Honorable Mention or Innovation Award as determined by the reviewers’

discussions.

– Final determination of Winners and Honorable Mentions are made at a

Board meeting that follows an independent review of applications.

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CONVINCE ME…

Did your organization improve health and

save money?

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THE LOGIC FLOW

A large proportion of diseases and disorders from which people suffer is preventable

Modifiable health risk factors are precursors to many diseases and disorders, and premature death.

Many modifiable health risks are associated with increased health care costs and diminished productivity within a relatively short time window.

Modifiable health risks can be improved through effective health promotion and disease prevention programs.

Improvements in the health risk profile of a population can lead to reductions in health costs and improvements in productivity.

Well-designed and well-implemented programs can be cost/beneficial – they can save more money than they cost, thus producing a positive return on investment (ROI).

1

2

3

4

5

6

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THE EVIDENCE

• A large proportion of diseases and disorders is preventable. Modifiable health risk

factors are precursors to a large number of diseases and disorders and to

premature death (Healthy People 2000, 2010, Amler & Dull, 1987, Breslow, 1993,

McGinnis & Foege, 1993, Mokdad et al., 2004)

• Many modifiable health risks are associated with increased health care costs

within a relatively short time window (Milliman & Robinson, 1987, Yen et al., 1992,

Goetzel, et al., 1998, Anderson et al., 2000, Bertera, 1991, Pronk, 1999)

• Modifiable health risks can be improved through workplace sponsored health

promotion and disease prevention programs (Wilson et al., 1996, Heaney & Goetzel,

1997, Pelletier, 1999)

• Improvements in the health risk profile of a population can lead to reductions in

health costs (Edington et al., 2001, Goetzel et al., 1999)

• Worksite health promotion and disease prevention programs save companies

money in health care expenditures and produce a positive ROI (Johnson & Johnson

2002, Citibank 1999-2000, Procter and Gamble 1998, Chevron 1998, California Public

Retirement System 1994, Bank of America 1993, Dupont 1990, Highmark, 2008)

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POOR HEALTH COSTS MONEY

Drill Down…

• Medical

• Absence/work loss

• Workplace safety

• Presenteeism

• Risk factors

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TOP 10 PHYSICAL HEALTH CONDITIONS

$0 $50 $100 $150 $200 $250

Angina Pectoris, Chronic Maintenance

Essential Hypertension, Chronic Maintenaince

Diabetes Mellitus, Chronic Maintenance

Mechanical Low Back Disor.

Acute Myocardial Infarction

Chronic Obstructive Pulmonary Dis.

Back Disor. Not Specified as Low Back

Trauma to Spine & Spinal Cord

Sinusitis

Dis. of ENT or Mastoid Process NEC

Medical Absence Disability

Source: Goetzel, Hawkins, Ozminkowski, Wang, JOEM 45:1, 5–14, January 2003.

(in thousands)

Medical, Drug, Absence, STD Expenditures (1999 annual $ per eligible), by Component

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THE BIG PICTURE: OVERALL BURDEN OF ILLNESS BY CONDITION

$0 $50 $100 $150 $200 $250 $300 $350 $400

Respiratory infections

Migraine/Headache

Hypertension

Heart Disease

Diabetes

Depression/Mental illness

Cancer

Asthma

Arthritis

Allergy

Inpatient Outpatient ER RX Absence STD Presenteeism

Source: Goetzel, Hawkins, Ozminkowski, Wang, JOEM 45:46:4, April 2004.

(in thousands)

Using Average Impairment and Prevalence Rates for Presenteeism ($23.15/hour wage estimate)

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INCREMENTAL IMPACT OF TEN MODIFIABLE RISK FACTORS ON MEDICAL EXPENDITURES

70.2%

46.3%

34.8%

21.4% 19.7%

14.5%11.7% 10.4%

-0.8%-3.0%

-9.3%

-25%

0%

25%

50%

75%

Depression Stress Glucose Weight Tobacco -

Past

Tobacco Blood

Pressure

Exercise Cholesterol Alcohol Eating

Source: Goetzel RZ, Anderson DR, Whitmer RW, Ozminkowski RJ, et al., Journal of Occupational and Environmental Medicine 40 (10) (1998): 843–854.

Percent Difference in Medical Expenditures: High-Risk versus Lower-Risk Employees

Independent effects after adjustment N = 46,026

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PepsiCo Study

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PEPSI BOTTLING GROUP - OVERWEIGHT/OBESE ANALYSIS

Adjusted predicted annual costs for employees by BMI

$0

$2,000

$4,000

$6,000

$8,000

$10,000M

ed

ical

ST

D

WC

Pre

sen

teeis

m

Ab

sen

ces

To

tal

Ad

juste

d p

red

icte

d a

nn

ual

co

st

Normal

Overweight

Class I

Class II

Class III

Difference between combined overweight/obese categories

and normal weight is displayed

Diff =

25%,

$987

Diff =

10%,

$28

Diff =

7%,

$49

Diff =

26%,

$186*Diff =

58%,

$111*

Diff =

29%,

$613*

74% of the

sample is

overweight or

obese

*At least one difference significant at the 0.05 level

Source: Henke RM, Carls GS, Short ME, Pei X, Wang S, Moley S, Sullivan M, Goetzel RZ. The Relationship between Health Risks and Health

and Productivity Costs among Employees at Pepsi Bottling Group. J Occup Environ Med. 52, 5, May 2010.

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NHLBI MULTI-CENTER STUDY: ESTIMATED ANNUAL COSTS OF HEALTHCARE UTILIZATION, ABSENTEEISM, AND PRESENTEEISM BY BMI CATEGORY

$1,416

$1,180

$2,034

$229

$1,402

$918

$1,544

$155

$182

$1,200

$872

$1,535

$149

$178

$219

$0 $500 $1,000 $1,500 $2,000 $2,500

Presenteeism

Absenteeism Days

Hospital Admissions

Emergency Room

Visits

Doctor Visits

Normal

Overweight

Obese

*

*

*

*

*

* P < .05

Source: Goetzel RZ, Gibson TB, Short ME, Chu BC, Waddell J, Bowen J, Lemon SC, Fernandez ID, Ozminkowski RJ, Wilson

MG, DeJoy DM. A multi-worksite analysis of the relationships among body mass index, medical utilization, and worker

productivity. J Occup Environ Med. 2010 Jan;52 Suppl 1:S52-8.

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DO WORKPLACE HEALTH PROMOTION PROGRAMS WORK? OUTCOMES OF MULTI-COMPONENT WORKSITE HEALTH PROMOTION PROGRAMS

Literature Review

• Purpose: Critically review evaluation

studies of multi-component worksite

health promotion programs.

• Methods: Comprehensive review of 47

CDC and author generated studies

covering the period of 1978-1996.

• Findings:

– Programs vary tremendously in

comprehensiveness, intensity & duration.

– Providing opportunities for individualized risk

reduction counseling, within the context of

comprehensive programming, may be the

critical component of effective programs.

Ref: Heaney & Goetzel, 1997, American Journal of Health Promotion, 11:3, January/February, 1997

EVALUATION OF WORKSITE HEALTH PROMOTION PROGRAMS — CDC COMMUNITY GUIDE ANALYSIS

Worksite Health Promotion TeamRobin Soler, PhDDavid Hopkins, MD, MPHSima Razi, MPHKimberly Leeks, PhD, MPHMatt Griffith, MPH

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CDC COMMUNITY GUIDE TO PREVENTIVE SERVICES REVIEW – AJPM, FEBRUARY 2010

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SUMMARY RESULTS AND TEAM CONSENSUS

Outcome

Body of

Evidence

Consistent

Results

Magnitude of

Effect Finding

Alcohol Use 9 Yes Variable Sufficient

Fruits & Vegetables

% Fat Intake

9

13

No

Yes

0.09 serving

-5.4%

Insufficient

Strong

% Change in Those

Physically Active

18 Yes +15.3 pct pt Sufficient

Tobacco Use

Prevalence

Cessation

23

11

Yes

Yes

–2.3 pct pt

+3.8 pct pt

Strong

Seat Belt Non-Use 10 Yes –27.6 pct pt Sufficient

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Outcome

Body of

Evidence

Consistent

Results Magnitude of Effect Finding

Diastolic blood pressure

Systolic blood pressure

Risk prevalence

17

19

12

Yes

Yes

Yes

Diastolic:–1.8 mm Hq

Systolic:–2.6 mm Hg

–4.5 pct pt

Strong

BMI

Weight

% body fat

Risk prevalence

6

12

5

5

Yes

No

Yes

No

–0.5 pt BMI

–0.56 pounds

–2.2% body fat

–2.2% at risk

Insufficient

Total Cholesterol

HDL Cholesterol

Risk prevalence

19

8

11

Yes

No

Yes

–4.8 mg/dL (total)

+.94 mg/dL

–6.6 pct pt

Strong

Fitness 5 Yes Small Insufficient

SUMMARY RESULTS AND TEAM CONSENSUS

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SUMMARY RESULTS AND TEAM CONSENSUS

Outcome

Body of

Evidence

Consistent

Results

Magnitude of

Effect Finding

Estimated Risk 15 Yes Moderate Sufficient

Healthcare Use 6 Yes Moderate Sufficient

Worker Productivity 10 Yes Moderate Strong

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WHAT ABOUT ROI?CRITICAL STEPS TO SUCCESS

Reduced Utilization

Risk Reduction

Behavior Change

Improved Attitudes

Increased Knowledge

Participation

Awareness

Financial ROI

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HEALTH AFFAIRS ROI LITERATURE REVIEWBaicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Aff (Millwood). 2010; 29(2). Published online 14 January 2010.

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RESULTS - MEDICAL CARE COST SAVINGS

Description N Average ROI

Studies reporting costs and

savings

15 $3.37

Studies reporting savings only 7 Not Available

Studies with randomized or

matched control group

9 $3.36

Studies with non-randomized or

matched control group

6 $2.38

All studies examining medical

care savings

22 $3.27

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RESULTS – ABSENTEEISM SAVINGS

Description N Average ROI

Studies reporting costs and

savings

12 $3.27

All studies examining

absenteeism savings

22 $2.73

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CASE STUDIES OF WINNERS

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CITIBANK, N.A.HEALTH MANAGEMENT PROGRAM EVALUATION

TITLE Citibank Health Management Program (HMP)

INDUSTRY

TARGET

POPULATION

Banking/Finance

DESCRIPTION

CITATIONS

47,838 active employees eligible for medical benefits

• A comprehensive multi-component health management program

• Aims to help employees improve health behaviors, better manage chronic conditions, and reduce demand for unnecessary and inappropriate health services,

• And, in turn, reduce prevalence of preventable diseases, show significant cost savings, and achieve a positive ROI.

• Ozminkowski, R.J., Goetzel, R.Z., Smith, M.W., Cantor, R.I., Shaunghnessy, A., & Harrison, M. (2000). The Impact of the Citibank, N.A., Health Management Program on Changes in Employee Health Risks Over Time. JOEM, 42(5), 502-511.

• Ozminkowski, R.J., Dunn, R.L., Goetzel, R.Z., Cantor, R.I., Murnane, J., & Harrison, M. (1999). A Return on Investment Evaluation of the Citibank, N.A., Health Management Program. AJHP, 44(1), 31-43.

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PROGRAM COMPONENTSHIGH-RISK PROGRAM

Questionnaire 1 (Program

Entry and Channeling

beginning January 1994

Letter/Report 1High-Risk

Letter/Report 1

High-Risk

Questionnaire

Letter/Report 2

High-Risk

Questionnaire

Letter/Report 3

High-Risk

Questionnaire

Letter/Report 4

Books,

Audiotapes,

Videotapes

Books,

Audiotapes,

Videotapes

Books,

Audiotapes,

Videotapes

Books,

Audiotapes,

Videotapes

Timeline

(months)

80% Low Risk 20% High Cost Risk

3 M

ON

TH

S6 M

ON

TH

S9 M

ON

TH

S

Self-Care Materials

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PROGRAM PARTICIPATION

47,838 54.3%

$10 3,000

All 47,838 active employees were

eligible to participate.

The participation rate was 54.3

percent.

Participants received a $10 credit

for Citibank’s Choices benefit plan

enrollment for the following year.

Approximately 3,000 employees

participated in the high risk

program each year it was offered.

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Source: Ozminkowski, R.J., Goetzel, R.Z., et al., Journal of Occupational and Environmental Medicine 42: 5, May, 2000, 502–511.

CITIBANK RESULTS

Percent of Program Participants at High Risk at First and Last HRA by Risk Category

(N=9,234 employees tracked over an average of two years)

95%

33% 32%

21%18%

12%

4% 2% 3% 1% 0%

19%

12%

2% 2% 2% 1% 0%

15%

26%31%

93%

0%

25%

50%

75%

100%

Fiber Stress Exercise Seatbelt BMI Tobacco Fat Cholesterol Salt Diastolic

Blood

Pressure

Alcohol

First HRA Last HRA

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CITIBANK RESULTS

Unadjusted

Impact**

Adjusted

Impact**

Net improvement* of at least

1 category versus others (N =

1,706)

-$1.86† -$1.91

Net improvement* of at least

2 categories versus others (N

= 391)

-$5.34 -$3.06

Net improvement* of at least

3 categories versus others (N

= 62)

-$146.87† -$145.77 ‡

Impact of improvement in risk categories

on medical expenditures per month

*Net Improvement refers to the number of categories in which risk improved minus number of categories in which risk stayed the same

or worsened.

**Impact = change in expenditures for net improvers minus change for others. Negative values imply program savings, since

expenditures did not increase as much over time for those who improved, compared to all others

† p < 0.05, ‡ p < 0.01

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CITIBANK: MEDICAL COST TRENDS OVER 38 MONTHS

$170

$212

$180

$257

$0

$50

$100

$150

$200

$250

$300

$350

Pre-HRA Post-HRATime Period

All Participants

n=11,219

Non-

Participantsn=11,714

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CITIBANK HEALTH MANAGEMENT PROGRAM ROI

$1.9 million*

PROGRAM COSTS

$8.9 million*

PROGRAM BENEFITS

$7.0 million*

PROGRAM SAVINGS

Notes:1996 dollars @ 0 percent discount.Slightly lower ROI estimates after discounting by either 3% or 5% per year.

ROI = $4.70 in benefits for every $1.00

in costs

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JOHNSON & JOHNSONHEALTH AND WELLNESS PROGRAM EVALUATION

TITLE J & J Health and Wellness Program (H & W)

INDUSTRY

TARGET

POPULATION

Healthcare

DESCRIPTION

CITATIONS

43,000 U.S. based employees

• Comprehensive, multi-component worksite health promotion program

• Evolved from LIVE FOR LIFE in 1979

• Goetzel, R.Z., Ozminkowski, R.J., Bruno, J.A., Rutter, K.R., Isaac, F., & Wang, S. (2002). The Long-term Impact of Johnson & Johnson’s Health & Wellness Program on Employee Health Risks. JOEM, 44(5), 417-424.

• Ozminkowski, R.J., Ling, D., Goetzel, R.Z., Bruno, J.A., Rutter, K.R., Isaac, F., & Wang, S. (2002). Long-term Impact of Johnson & Johnson’s Health & Wellness Program on Health Care Utilization and Expenditures. JOEM, 44(1), 21-29.

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HEALTH & WELLNESS PROGRAM IMPACT ON EMPLOYEE HEALTH RISKS (N=4,586)

High Risk Group

After an average of 2¾ years, risks were reduced in eight categories but increased in four related categories: body weight, dietary fat consumption, risk for diabetes, and cigar use.

66.2%

49.6%

45.8%

32.7%

9.7%

4.5% 3.5%1.3%

2.7% 2.9%

23.9%

35.1%

41.0%43.2%

0%

10%

20%

30%

40%

50%

60%

70%

High

Cholesterol

Low Fiber

Intake

Poor Exercise

Habits

Cigarette

Smoking

High Blood

Pressure

Seat Belt Use Drinking &

Driving

Pe

rce

nt

Ide

nti

fie

d a

t R

isk

Time 1 Health Profile Time 2 Health Profile

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JOHNSON & JOHNSON HEALTH & WELLNESS PROGRAM IMPACT ON MEDICAL COSTS

$45.17

$70.89

$118.67

$224.66

-$10.87

-$50.00

$0.00

$50.00

$100.00

$150.00

$200.00

$250.00

ER Visits Outpatient/Doctor

Office Visits

Mental Health Visits Inpatient Days OVERALL SAVINGS

Source: Ozminkowski et al, 2002 — N=18,331

$225 Average Annual Medical Savings/ Employee/Year 1995-1999

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Per Employee Per Year, 1995 – 1999 -- Weighted by sample sizes that

range from N = 8,927 – 18,331, depending upon years analyzed

$(100.00)

$-

$100.00

$200.00

$300.00

$400.00

$500.00

IP days

MH visits

OP visits

ER visits

IP days $60.76 $94.25 $164.72 $195.80

MH visits $78.42 $55.05 $51.49 $103.43

OP visits $1.54 $23.57 $186.03 $181.27

ER visits $(12.15) $(14.43) $(7.27) $(8.06)

1 2 3 4

Years Post Implementation

INFLATION-ADJUSTED, DISCOUNTED HEALTH AND WELLNESS

PROGRAM CUMULATIVE SAVINGS

2002 2003 2004 2005 2006 2007 2008

J&J $3,786 $3,652 $4,048 $3,734 $3,819 $3,896 $3,984

J&J Expected* $3,786 $3,969 $4,160 $4,361 $4,571 $4,792 $5,023

Savings $0 $317 $112 $627 $752 $896 $1,039

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

Pre

dic

ted

An

nu

al A

ve

rag

e T

ota

l C

osts

JOHNSON & JOHNSON – 2002-2008 MEDICAL COST TREND

Average

Annual %

Change*

+1.0%

+4.8%

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MarketScan comparison group (N=16 companies) and Johnson & Johnson percentage annual

change amounts derived from growth curve model estimates retransformed to dollars and

adjusted for inflation.

*Expected cost if Johnson & Johnson had comparison group growth trend.

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Source: Goetzel, R.Z., Jacobson, B.H., Aldana, S.G., Vardell, K., and Yee, L. Journal of Occupational and Environmental Medicine, 40:4, April, 1998.

PROCTER & GAMBLE

Total Annual Medical Costs For Participants and Non-Participants In Health Check (1990 - 1992)

Adjusted for age and gender; Significant at p < .05

*In year 3 participant costs were 29% lower producing an ROI of 1.49 to 1.00

Health Reform Initiative

http://www.metrokc.gov/employees/M_E_Report/

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HEALTH CARE ENVIRONMENT

• 13,000 employees

• 30,000 plan members

• Strong Labor Unions – 92 separate bargaining units

• Dwindling tax base, rising public expectations

• Comprehensive medical, dental, vision

• 2012: Health plan costs will double under status quo to $300+

Million

PROGRAM EFFECT ON HEALTH RISKS: AGGREGATE 2006, 2008 (EMPLOYEES AND SPOUSES/PARTNERS)

Program Effect on Health Risks:

2006, 2008 all respondents -Employees and Dependents (N=16549 in 2006, N=17068 in 2008)

Health risks

Program

effect

Adjusted Odds Ratio 95%

Confidence Interval

p-value

adjusted prevalence Adjusted change

(Reference=

2006)Lower CI Upper CI 2006 2008

Alcohol Use -0.25 0.71 0.85 <.0001 4.70% 3.58% -1.11%

Depression -0.28 0.71 0.81 <.0001 10.97% 8.53% -2.44%

Injury Prevention -0.42 0.63 0.69 <.0001 18.16% 12.91% -5.25%

Mental Health -0.31 0.7 0.77 <.0001 25.72% 20.22% -5.51%

Nutrition -0.45 0.61 0.66 <.0001 75.19% 66.17% -9.02%

Physical Activity 0.01 0.97 1.05 0.7084 37.42% 38.03% 0.61%

Sun Damage Behavior -0.41 0.64 0.69 <.0001 25.95% 18.91% -7.04%

Smoking Behavior -0.47 0.59 0.66 <.0001 10.98% 7.24% -3.74%

Stress Behavior -0.32 0.69 0.76 <.0001 22.49% 17.36% -5.13%

BMI risk -0.15 0.84 0.89 <.0001 64.52% 61.63% -2.89%

Blood Glucose 0.01 0.93 1.1 0.86 33.21% 34.04% 0.83%

Cholesterol -0.35 0.66 0.75 <.0001 35.43% 28.28% -7.15%

Systolic BP -0.51 0.53 0.67 <.0001 6.88% 4.44% -2.43%

Diastolic BP -0.32 0.65 0.82 <.0001 6.24% 4.67% -1.56%

Last column green cells indicate significant decrease, white cells indicate insignificant changes.

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BASELINE, TARGETED AND ACTUAL EMPLOYEE HEALTH CARE COSTS – 2003 - 2008

Growth of King County

& Employees'/Families' Health Care Costs

2005/2008 Trend Compared to 2003/2004 Trend

$80M

$88M

$109M

$98M

$148M

$134M

$120M

$98M

$109M

$118M

$129M

$140M

$97M

$107M

$113M

$126M

$70M

$80M

$90M

$100M

$110M

$120M

$130M

$140M

$150M

2003 2004 2005 2006 2007 2008 2009

Kin

g C

ount

y C

laim

s +

Empl

oyee

s'/F

amili

es' S

hare

Projected Health Care Cost Trend for '03-'04 Pre-HRI: 10.8%

Targeted Medical/Rx Costs Rising at 8.9% after 2006

Actual Health Care Costs

Projected Health Care Cost Trend

Council-approved Health Care Cost Trend Target after 2006: 8.9%

Growth of King County & Employees’/Families’ Health Care Costs

2005/2008 Trend Compared to 2003/2004 Trend

__

First

Wellness

AssessmentHRI

Start-up

New

Bronze/Silver/Gold

Incentives

Projected Health Care Cost Trend for ’03-’04 (Pre-HRI): 10.8%

Actual Health Care Cost Trend for ’05-’08 (Post-HRI): 8.8%

Actual Health Care Cost

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SUMMARY

The Health Project aims to recognize

organizations that have documented health

improvements AND cost savings.

Size is not important – results are!

A growing body of scientific literature, and real-

world examples, suggest that well-designed,

evidence-based health promotion programs can:

• Improve the health of workers and lower their risk

for disease;

• Save businesses money by reducing health-

related losses and limiting absence and disability;

• Heighten worker morale and work relations;

• Improve worker productivity; and

• Improve the financial performance of

organizations instituting these programs.

From the Desk of Dr. C. Everett Koop Former U.S. Surgeon

General, 1981-1989

I hope that you will consider joining us during this exciting time as together

we look to the future of The Health Project.

Sincerely,

Our Website

• http://www.thehealthproject.com/